Patient Safety

Success Stories

Influenza, a contagious respiratory illness spread by droplets, can lead to hospitalization and even death. Millions of people get influenza each year, hundreds of thousands are hospitalized, and thousands to tens of thousands die from influenza related causes each year. The key to preventing a devastating outbreak is vaccinating enough people that an outbreak is unlikely.
When Allina Health identified that its own rates for influenza vaccination were lower than desired, the health system studied data gleaned from its EHR and an Analytics Platform from Health Catalyst, which includes a Late-Binding™ Enterprise Data Warehouse and broad suite of analytics applications, to understand its true current vaccination performance. The data revealed that changes were in order, which Allina put in place through clinician feedback, engagement, and education.
Results:

4.8 percentage point improvement in influenza vaccination rate, exceeding the Healthy People 2020 goals for vaccination.

Each day, 91 Americans die from an opioid overdose. Historically, illegal opioids, such as heroin, were the primary contributing factor to overdoses. Today, it is well understood that a driving force for opioid abuse is prescriptions, which contribute significantly to the overdose epidemic.
Following a series of adverse outcomes related to opioid misuse within the community, Allina Health sought to evaluate how it managed acute non-cancer pain in the outpatient setting, particularly among opioid-naïve patients. By leveraging the Health Catalyst Analytics Platform, including the Late-Binding™ Data Warehouse and broad suite of analytics applications, Allina Health obtained data on prescribing patterns and identified several opportunities to reduce the number of opioids prescribed.
Results:

Intravenous (IV) heparin is widely used to prevent thrombosis in a variety of clinical settings, yet it is considered one of the highest-risk medications used in the inpatient setting because of the potential for dosing errors. Allina Health identified multiple IV heparin protocols among its hospitals, a variation that increased the risk of errors. Standard practices that addressed patients’ clinical needs in a disease-specific way were lacking. Over the course of 1.5 years, more than 9,000 patients at Allina Health had an IV heparin protocol ordered, so IV heparin safety was of utmost concern.
To address this quality issue and improve clinical value, Allina Health created a systemwide interdisciplinary team to standardize IV heparin therapeutic guidelines and monitor the impact of the standard guideline on patient outcomes. Allina Health engaged multiple physician stakeholder groups to review proposed protocols and provide critical feedback to help ensure the best possible patient care and safety. To effectively monitor IV heparin outcomes, patient safety, and the impact of the new, standard guidelines and protocols, Allina Health developed an anticoagulation safety analytics application, using the Health Catalyst Analytics Platform, including the Late-Binding™ Data Warehouse and broad suite of analytics applications. These outcomes improvement efforts resulted in:

A seven percent relative improvement in the percentage of patients therapeutic within 24 hours of protocol initiation.
Paring 20+ site-based documents (e.g., policies, protocols, and order sets) to one systemwide guideline and four systemwide protocols.

Since 2004, the US healthcare system has annually ranked last relative to 10 other developed nations in quality, access, efficiency, equity, and health outcomes. In an effort to improve the quality of care and patient outcomes in the U.S., the Center for Medicare and Medicaid (CMS) launched a series of quality incentive programs designed to generate a shift from volume to value-based reimbursement. The health insurance industry soon followed their lead, and started writing contracts with hospitals in which a percentage of payment was based on performance on selected quality metrics.
Faced with the challenge of reporting on numerous incentive programs with differing expectations, Mission Health leveraged their enterprise data warehouse to aggregate the data needed to track the quality measures. With millions of dollars on the line with one particular payer, Mission developed an analytics application to monitor performance on the metrics in that contract. The application was used to analyze whether performance feedback and workflow changes would lead to improved performance on the metrics, thus ensuring that they would maximize reimbursement, while improving care for patients.
Results:

Achieved 100 percent of all at risk dollars.
100 percent of the ambulatory metric targets were exceeded, some by as much as 19 percent.
All five hospitals exceeded targets for 80 percent or more of their inpatient metrics.

Each year, more than 12,700 pediatric patients are diagnosed with diabetic ketoacidosis (DKA), a life threatening complication of diabetes. Texas Children’s Hospital sought a way to accurately predict risk of DKA in time for care team members to intervene before these patients suffered a severe episode.
The health system ultimately formed a multidisciplinary high risk diabetes team to devise pre- and post-discharge strategies, and DKA risk prediction tools aided by the Health Catalyst Analytics Platform built using the Late-BindingTM Data Warehouse.
Results:

30.9 percent relative reduction in recurrent DKA admissions per fiscal year.
90 percent of all patients with new onset type 1 diabetes at the Medical Center Campus have a documented RIPGC in their medical chart.
100 percent of patients with type 1 diabetes have a risk index for DKA documented every 6 months.

Unprecedented changes in the healthcare payment system have resulted in health organizations across the country investing in the pursuit of the Institute for Healthcare Improvement’s (IHI’s) Triple Aim to improve population health, improve patient experience and outcomes, and reduce costs per capita. Health organizations must develop effective population health management strategies, and they need the right data and analytics to inform their initiatives.
Once armed with the information to make data-driven decisions, leading healthcare providers are implementing care management programs, which have proven to be helpful mechanisms for achieving the Triple Aim. Many healthcare organizations have identified specific patient cohorts to monitor the impact of care management interventions on individual and population health outcomes.
Data-driven care management programs that target high-risk and rising-risk patients can achieve impressive results, including:

A stay in the intensive care unit (ICU) is both costly and risky. In a sobering example of the latter, nearly one third of patients admitted to the ICU experience delirium, a state of cognitive impairment that can increase risk of death in the hospital. Still, many cardiovascular patients need intensive care that can only be provided safely in an intensive care unit, requiring hospitals to assure enough beds and skilled ICU staff for these patients—while quickly identifying which patients can receive care as good or better in another unit.
Allina Health has achieved this dual objective with a concerted ICU avoidance strategy for specific complex sub-populations of cardiovascular (CV) patients. The foundation of this strategy is risk-informed decisions about which patients can avoid the ICU; clinical staff education; and an analytics platform and enterprise data warehouse (EDW) from Health Catalyst that enables CV care leaders to monitor safety metrics for those patients who avoid a stay in the ICU. So far, Allina Health’s efforts have resulted in the following achievements:

Post Operative Atrial Fibrillation occurs in up to 30 percent of all patients after cardiac surgery. This serious complication increases the length of the patient’s hospital stay, and is associated with a twofold increase in the incidence of cerebral infarction and an increased risk of 30-day mortality. Timely and consistent management of Post Op Afib can prevent significant complications and help prevent death. To standardize such an approach to managing Post Op Afib, Allina Health’s Minneapolis Heart Institute created a physician committee to raise consensus on and develop a protocol for Post Op Afib management.
The committee ultimately created a nurse-driven protocol and decision support algorithm linked to the health system’s electronic health record (EHR). Additionally, it uses analytics, supported by Health Catalyst’s Late-Binding™ Enterprise Data Warehouse (EDW), to track physician ordering rate, patient outcomes, and cost. This combination of people, processes, and analytics tools has made a significant difference for Allina and its patients.

Percutaneous Cardiac Intervention (PCI) is a minimally-invasive alternative to open heart surgery—a procedure that approximately 600,000 U.S. patients will undergo this year.
Allina Health, a non-profit health system with 90+ clinics and 13 hospitals with locations throughout Minnesota and western Wisconsin, is a leading provider of the procedure in Minnesota. Allina Health discovered that major bleeding events following PCI procedures (the most common non cardiac complication of PCI), though not affecting mortality, were increasing length of stay (LOS) and cost.
To improve the quality of its PCI procedures and decrease costs, Allina Health recognized the need to accurately assess bleeding risk and then implemented best-practice interventions to prevent major bleeding events.
Already, physicians and patients have seen that these new interventions, which includes a bleeding risk assessment tool, allows clinicians to focus interventions based on risk and reduce complications. The top results from Allina Health’s interventions include:

By the age of 60, more than one-third of women in the United States have had a hysterectomy. Healthcare systems across the country are recognizing that a women’s health service line offers a pathway to improving care and decreasing cost for these patients. Having accurate activity-based costing information is necessary to uncover opportunities for clinical practice improvement and cost reduction.
The University of Pittsburgh Medical Center (UPMC) made the decision to organize Women’s Health as a service line across the entire health system. UPMC fortified this approach with strong and collaborative leadership, an enterprise data warehouse, and an activity-based cost management system. The results:

20 percent reduction in inpatient length of stay for hysterectomies (over a three-year time period)
34 percent reduction in open hysterectomies
28.3 percent reduction in 30-day readmissions for hysterectomies

These results were obtained during a time when this clinical service saw a 25 percent improvement in its contribution margin.

The U.S. healthcare system is the most expensive in the world, but data consistently shows the U.S. underperforming relative to other countries on most dimensions of performance. The Centers for Medicare & Medicaid Services’ (CMS’s) accountable care organization (ACO) model is aimed at addressing that issue by offering financial incentives for providers to improve the health of populations and reduce costs through greater efficiencies and a focus on preventive care.
Mission Health formed a Medicare Shared Savings Program (MSSP) ACO called Mission Health Partners (MHP), which is responsible for 40,000 patient lives. MHP knew that its manual approach to data collection and reporting would not be sufficient for the required ACO quality metrics. By leveraging a previously implemented enterprise data warehouse platform and implementing an ACO MSSP analytics application, MHP was able to automate the processes of data-gathering and analysis and align the data with ACO quality reporting measures. The visibility and transparency of near real-time, online performance data coupled with focused process improvement has resulted in subsequent improvement in all 33 of the ACO performance metrics. Specifically, improvements have included:

9.6 percent increase in compliance over all reported ACO metrics, with 23,000 more patients receiving recommended treatment or screenings.
98.9 percent of eligible patients received screenings for clinical depression and follow up.
40 percent increase in number of patients receiving any cancer screening; 46 percent improvement in the number of patients receiving colorectal cancer screening.
456 percent increase in the number of patients getting fall risk screening.

Hospital-acquired conditions (HACs)—such as central line-associated blood stream infections (CLASBIs) and pressure ulcers (PUs)—cause harm and adversely affect patients’ lives, while also increasing hospital length of stay (LOS) and total hospital costs. In fact, each case of CLABSI alone costs up to $55,000 to treat and makes health systems vulnerable to reimbursement penalties.1
Children’s Hospital of Wisconsin (CHW), a nationally ranked pediatric center with two hospitals and a surgery center, recognized that reducing the rate of HACs in its facilities would require major systematic changes. CHW’s approach to transforming care to prevent HACs included cultural changes with an emphasis on staff education and engagement and a new governance structure to support the initiative. These changes were powered by high-tech tools and quicker access to new types of data that CHW didn’t have in the past.
The hospital’s implementation of its comprehensive and collaborative HAC reduction plan has resulted in measurable quality of care improvements and cost reductions, including:

$1.6 million savings realized to date as a result of a 30 percent reduction in the overall number of HACs
23 percent reduction in central line-associated blood stream infections (CLABSIs)
74 percent reduction of pressure ulcers (PUs)
68 percent reduction in venous thromboembolisms (VTEs)

U.S. hospital stays cost the health system at least $377.5 billion per year. In today’s value-based care environment, hospitals are under increasing pressure to avoid patient harm and maintain quality while also lowering costs. Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals.
El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. However, when it came to its goal of reducing LOS, leaders recognized that they faced some major challenges, including:

The complexity of implementing a multi-layered, multi-disciplinary approach to improving the patient discharge process.
Identifying what issues were contributing the most to increased LOS so that they could be addressed.

By implementing analytics and protocols that provide access to actionable data, the LOS reduction team was able to identify patients at high risk for increased LOS so that they could develop and track critical interventions. El Camino’s patient-centered approach to tackling LOS reduction also included multi-disciplinary cooperation, leadership buy-in, and additional resources to enhance discharge care coordination.
This innovative, systematic approach resulted in not only a better than anticipated reduction in ALOS of 7.8 percent, but also:

One in three pregnant women give birth via cesarean section in the United States, which is more than double the rate the World Health Organization (WHO) recommends. And instead of decreasing, the overall C-section rate in Washington State increased 73 percent from 1996 to 2009. C-section rates are just one area of maternal care where our practice in the U.S. lags behind the science and knowledge of best practice. MultiCare Health System believes that all of its female patients should experience the same high-quality care across its integrated delivery system. The health of the next generation depends on it.
MultiCare recognized that it had to standardize care across its system to meet quality standards, improve its patients’ experiences and outcomes, and maintain its market share. The health system launched a Women’s Collaborative, the sole purpose of which was to improve clinical care and patient outcomes for women’s services systemwide.
By working with clinicians to implement standards of care, and using analytics to measure performance, the Women’s Collaborative achieved the following:

NTSV (low-risk, rst-time mother) C-section rate 9 percent less than the national average and already below the 2022 national goal of 23.9 percent
Six-point increase in market share for inpatient OB/GYN services
Improvements in care delivery:

Stroke is a leading cause of hospitalizations among elderly often resulting in serious long-term disability, readmissions (up to 27% are readmitted to the hospital in year one), or secondary stroke. Allina Health’s Courage Kenny Rehabilitation Institute (CKRI) had deployed a successful care coordination model for other complicated, high-risk populations that it was confident would help stroke patients, as well.
CKRI created a holistic program for stroke patients that delivers comprehensive, seamless care across inpatient, outpatient and support services. A data warehouse and analytics platform merges data across the care continuum, and enables Allina to target high-risk stroke patients for coordinated care, track their progress and measure their outcomes.
Within a year, Allina was able to prove the value of this new care model for stroke by realizing $350,000 in cost savings and, most importantly, through actual lives saved and improved.

Like most large healthcare systems throughout the country, Allina Health’s financial health improves dramatically by optimizing inpatient care for the patients it serves.
Allina recognized optimizing length of stay (LOS) was one of the key drivers of its inpatient financial performance and developed the technical infrastructure and analytic capabilities to understand LOS performance by the minute and not the day; adjust LOS to account for patient acuity and compare performance to national benchmarks; make LOS data available to clinicians across the organization in near real-time; and estimate the financial impact of LOS opportunities to enable targeted interventions for improvement.
Allina leveraged its enterprise data warehouse (EDW) and analytics platform and optimized LOS, yielding the following results in the first two years of its improvement efforts:

26,000+ inpatient days saved
$13.4 million in direct operating expenses saved
Hospital capacity (bed availability) created for 5,000+ admissions
Avoided adverse patient events and reduced the total cost of care

An estimated 1 million cases of venous thromboembolism (VTE) occur each year in the United States—with approximately 300,000 of these cases resulting in death. These sobering statistics led Allina Health to embark on a journey to address prevention and improved care for its VTE patients—one of the most common causes of hospital-related death in the United States—and one of the most preventable. Supported with analytics, Allina implemented a physician-led, multidisciplinary workgroup to standardize order sets and engage clinicians in improvement efforts. To date, their system-wide efforts have generated measurable improvements including an 11 percent increase in VTE bundle compliance rate, a 96.9 percent compliance with VTE prophylaxis, and a 41 percent increase in compliance with VTE warfarin therapy discharge instructions.

To tackle the variation and waste that can arise from different treatment decisions, Allina Health developed a solid framework to establish and deploy standard, evidence-based practices across the enterprise. The transition to a standard evidence-based decision-making process required collaboration and buy-in from multiple stakeholders and physicians. Allina’s established quality governance structure reviewed and approved system-wide clinical practice guidelines for Stage 1 lung cancer treatment and IV heparin treatment. To sustain and improve on this new model of care, a comprehensive checklist was developed to ensure that all future guidelines are based on patient subgroups and preferences, available evidence, stakeholder review, and other important criteria including IOM standards. Adherence to guidelines is monitored with metrics based on data extracted from Allina’s enterprise data warehouse and from the electronic health record. Results to date already indicate notable improvements in variation and cost, including the following: the establishment of a system-wide EBDM model and policy, 20 system-wide approved evidence-based guidelines developed months faster, a 5 percent decrease in Stage 1 lung cancer treatment variation, and a 20 percent decrease in the number of heparin protocols.

Low back pain (LBP) is a common and expensive problem. The annual cost to patients, employers, and insurers collectively exceeds $100 billion in the U.S. alone. Additionally, LBP care treatment variations, impact outcomes. In 2011, Allina Health created the Spine Institute to deliver care that supports the IHI Triple Aim in the treatment of spine disorders and LBP. All clinical disciplines involved in spine care are part of the program, and care providers follow standard spine care and management evidence-based models. Access to quality data enables Allina to measure performance across providers. With this successful spine care coordination program and advanced clinical analytics, Allina has reduced length of stay by 16 percent and post-op complications by 3.6 percent, while projecting $2.7 million in savings.

Advancing women’s health is a key part of the nation’s healthcare quality improvement and population health management agenda. Mission Health has embarked on a journey to standardize its best practices and develop a more systematic method for collecting and analyzing data related to perinatal care. With an EDW serving as its analytics platform, and a newly implemented clinical improvement model, Mission is able to monitor performance on several evidence-based practices designed to improve maternal and newborn care. Learn how they have sustained a zero elective delivery rate, and how they have reduced the time they spend manually collecting data and calculating rates.

Sepsis, a serious complication that strikes quickly and is often fatal, is the single most expensive condition to treat in the hospital, in part because of the longer than average stay. To reduce sepsis mortality rates, which are between 20 and 50 percent, many hospitals have established evidence based bundles comprised of antibiotic administration, lactate level monitoring and other elements of care. However, without analytics, hospitals rely on manual processes to track sepsis rates and bundle compliance. Learn how Mission Health has streamlined surveillance by 75% while experiencing a 2.6% reduction in sepsis mortality rates and an 18% reduction in length of hospital stay.

Despite the preventability of healthcare associated conditions (HACs), rates continue to be unacceptably high throughout the country. Developing and implementing best-practice bundles—and tracking providers’ compliance with these bundles—has proven to be highly effective in preventing HACs. However, tracking HAC rates and bundle compliance can present a significant reporting burden. Learn how this healthcare organization has streamlined reporting and is able to identify vulnerable patients sooner, monitor clinicians’ compliance with best-practice bundles, and minimize manual chart reviews to calculate the HAC rates. With increased bundle compliance, their overall HAC rate has decreased by 35% and their CAUTI rate by 50%.

Studies have shown that elective deliveries before 39 weeks increase the risk of newborn respiratory distress as well as increase the rates of C-sections where there is a higher rate of postpartum anemia and longer lengths of stay for both mothers and babies. Payers are partnering with healthcare organizations to lower elective delivery rates. Learn how this healthcare organization reduced their elective deliveries by 75 percent in just six months and received a six-figure payer partner bonus.

Northwest healthcare organization Multicare reduced septecemia by 22 percent, leading to a $1.3 million cost savings in the same period. Now the organization is tackling other areas of improvement. Discover what triggered the improvements — and how these resulted in savings.